NPIMap

Organization Active NPI

Boone Memorial Hospital, Inc

Doing business as Boone Memorial Hospital

  • Critical Access Hospital
  • Madison, WV
National Provider Identifier
1639135221
Registry record updated May 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
119 Issued in WV
Legal business name
BOONE MEMORIAL HOSPITAL, INC
Doing business as
Boone Memorial Hospital
Practice address
701 Madison Ave
Madison, WV 25130-1669
Phone
(304) 369-1230
Fax
(304) 369-6036
NPI assigned
Apr 24, 2006
Last updated
May 29, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Douglas Cole Malcolm
Title
Cfo
Phone
(304) 688-1823

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 119 WV Primary
Institutional Pharmacy 3336I0012X IP0550770 WV

Addresses

Primary practice location

701 Madison Ave
Madison, WV 25130-1669

Mailing address

701 Madison Ave
Madison, WV 25130-1669
Phone (304) 369-1230

Other identifiers 2

IdentifierTypeStateIssuer
0102256000MedicaidWV
2109661OtherPK

Other names 1

  • BOONE MEMORIAL HOSPITAL Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20061104000273 WV Part A Provider - Critical Access Hospital 3375433352 Receives reassigned benefits from 129 practitioners
Practice locations: Madison, WV
O20200206000829 WV MDPP Supplier - in-Person MDPP Supplier 3375433352 Practice locations: Madison, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639135221. Details of each certification follow.

Hospital certification: CCN 511313

Legal name
BOONE MEMORIAL HOSPITAL INC
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Feb 1, 2004
Last certification
Jun 29, 2011
Beds
25
Ownership / control type
Local
Most recent change of ownership
Jul 1, 2012 (2 total)
Organization structure
CorporationNon-profit
Incorporated
Sep 16, 2010 in WV
Enrollment address
701 Madison Avenue
Madison, WV 25130-1699
Other Hospital Practice Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospital

Medicare Care Compare
Listed as
Boone Memorial HospitalCCN 511313 · All quality measures
Overall star rating
4 of 5
Type
Critical Access Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Boone Memorial Hospital Inc11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

600 S Main St
#A
Madison, WV 25130

701 Madison Ave
Ste 100
Madison, WV 25130

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Douglas Cole Malcolm Individual W-2 Managing EmployeeCfo Oct 3, 2022
Boone Memorial Hospital Inc Organization, Madison, WV Created for acquisition, Corporation 5% Or Greater Direct Ownership Interest Jul 1, 2012 100%
Virgil L Underwood Individual Corporate Director Jul 1, 2012
W-2 Managing EmployeeCeo Feb 2, 2015

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Boone Memorial HospitalMadison, WV, CCN 51Z313 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2012
BMH Family Medical CenterMadison, WV, CCN 513992 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2012
BMH Medical ClinicMadison, WV, CCN 513411 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2012
BMH Comfort ClinicComfort, WV, CCN 513433 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 25, 2022
Aug 28, 2022

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 149

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 149

Affiliated clinicians 213

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 213

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748476800000",
    "number": "1639135221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 MADISON AVE",
            "city": "MADISON",
            "state": "WV",
            "postal_code": "251301669",
            "telephone_number": "304-369-1230",
            "fax_number": "304-369-6036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 MADISON AVE",
            "city": "MADISON",
            "state": "WV",
            "postal_code": "251301669",
            "telephone_number": "304-369-1230",
            "fax_number": "304-369-6036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOONE MEMORIAL HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-24",
        "last_updated": "2025-05-29",
        "certification_date": "2025-05-29",
        "status": "A",
        "authorized_official_last_name": "MALCOLM",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "COLE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "304-688-1823"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "WV",
            "license": "119",
            "primary": true
        },
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "WV",
            "license": "IP0550770",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0102256000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2109661",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BOONE MEMORIAL HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BOONE MEMORIAL HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison, WV

Sources for this page

Verify at the official NPI Registry.